Health Policy Research

Reports

• "A Continuing Program for Increasing Insurance Coverage Among Low-Income Families." Covering Kids & Families Evaluation. Judith Wooldridge, Beth Stevens, Christopher Trenholm, Eileen Ellis, and Ian Hill, June 2010. This evaluation of the Robert Wood Johnson Foundation’s Covering Kids & Families^® (CKF) program examined ways to improve the program and assess CKF’s effects on policy and procedures, as well as the effects of policy and procedures on coverage.
• "Projected Health Care Spending in Minnesota." David Jones and Deborah Chollet, July 2010. This report projects health care spending in Minnesota from 2008 to 2018, updating Mathematica’s earlier projections completed in 2009. Changes to the input data are documented, as are changes to the methodology to account for the recession’s spending impacts and health care reform.
• "Establishing and Maintaining Medicaid Eligibility Upon Release from Public Institutions." Audra Wenzlow, Henry T. Ireys, Carol Irvin, and Matthew Hodges, June 2010. This report describes an evaluation of Oklahoma’s efforts to develop and implement a model program to ensure that eligible individuals with mental illness were enrolled in Medicaid at discharge from state prisons and institutions for mental diseases.
• "Care Coordination and Disease Management." Debra Lipson and Melanie Au, In State Roles in Delivery System Reform, National Governors Association, July 2010. This report reviews evidence and opportunities for governors to control health care costs and improve outcomes through quality initiatives, coordinated care, primary care and prevention, and payment reforms.
• "Provider Payment: Trends and Methods in the Massachusetts Health Care System.” Allison Barrett and Timothy Lake, February 2010. This report investigates provider payment methods in Massachusetts. Payments include fee-for-service, the predominant model; global payments, which pay providers a single fee for all or most required services during a contract period; and pay-for-performance models, which layer quality incentives onto payments.
• “Strategies for Reining in Medicare Spending Through Delivery System Reforms: Assessing the Evidence and Opportunities.” Randall Brown, September 2009. This paper reviews proposed reforms to strengthen Medicare’s long-term fiscal outlook. Looking beyond provider payment reductions, the author assesses leading strategies to improve quality of care and efficiency within Medicare as well as the overall health care system. The paper argues that many of the most prominent proposed reforms are not likely to achieve savings for Medicare in the next 10 years, but identifies approaches that hold real promise for generating savings by either reducing chronically ill beneficiaries’ need for expensive services or changing providers’ practices in ways that decrease unnecessary procedures and inefficiencies. A companion paper synthesizes evidence on cost-effective interventions, identifies issues to resolve for ongoing research, and recommends care coordination policies supported by available evidence. Read more about Mathematica's evaluation of the Medicare Coordinated Care Demonstration. 
• “Enhanced Primary Care Case Management Programs in Medicaid: Issues and Options for States.” James Verdier, Vivian Byrd, and Christal Stone, September 2009. This report examines how five states—Oklahoma, North Carolina, Pennsylvania, Indiana, and Arkansas—have enhanced their Medicaid primary care case management (PCCM) programs to provide more intensive care management and care coordination for high-need beneficiaries, improve financial and performance incentives for primary care providers, and increase use of performance and quality measures. The report is aimed at states that may not have the option of contracting with fully capitated at-risk managed care organizations (MCOs), or that may want to use PCCM programs as an option for beneficiaries and as a source of competition and comparison for MCOs.

Journal Articles

• "Examining Effectiveness of Medical Interpreters in Emergency Departments for Spanish-Speaking Patients with Limited English Proficiency: Results of a Randomized Controlled Trial." Ann D. Bagchi, Stacy Dale, Natalya Verbitsky-Savitz, Sky Andrecheck, Kathleen Zavotsky, and Robert Eisenstein, Annals of Emergency Medicine, August 2010. This article examines whether availability of in-person professional interpreter services during emergency department visits affects satisfaction of limited English proficient patients and their health providers, using a randomized controlled trial.
• "Differences in Prevalence, Treatment, and Outcomes of Asthma Among a Diverse Population of Children with Equal Access to Care." Kate A. Stewart, Patricia C. Higgins, Catherine G. McLaughlin, Thomas V. Williams, Elder Granger, and Thomas W. Croghan, Archives of Pediatrics & Adolescent Medicine, August 2010 (subscription required). This article assesses racial and ethnic differences in asthma prevalence, treatment patterns, and outcomes for children enrolled in the Department of Defense’s health insurance program, TRICARE.
• "Enrolling the Eligible: Lessons for Funders." Beth Stevens, Sheila Hoag, and Judith Wooldridge, Foundation Review, March 2010 (subscription required). This article describes lessons from Covering Kids & Families® (CKF) and covers topics such as how outreach, simplification, and coordination increase enrollment of low-income children and their families in Medicaid and SCHIP. The authors suggest that funders should consider the program’s life cycle—start-up, maturity, or perpetuation/death—both for what is funded and how it is evaluated.
• "Therapeutic Alliance in Pediatric Primary Care: Preliminary Evidence for a Relationship with Physician Communication." Lawrence S. Wissow, Jonathan D. Brown, and Janice Krupnick, Journal of Developmental Behavioral Pediatrics, February/March 2010 (subscription required). This article found it is possible to use a variation of the Vanderbilt Therapeutic Alliance Scale (VTAS) to rate parent-provider interactions in pediatric primary care. Measuring therapeutic alliance may be a useful tool in evaluating interventions to improve the delivery of mental health services in primary care because of its potential specificity as a marker of mental health-related outcomes.
• "How Temporary Insurance for High-Risk Individuals May Play Out Under Health Reform." Deborah Chollet, Health Affairs, June 2010. This article identifies continuing issues and barriers for many consumers seeking health coverage in high-risk insurance pools under the new Patient Protection and Affordable Care Act. The article notes how the new federal program is intended to serve only the currently uninsured—leaving in place until 2014 the states’ existing high-risk pools for many denied private coverage.
• A national symposium on the patient-centered medical home brought together experts in primary care, health services and implementation research, health systems and insurance, as well as policymakers to develop a research agenda. The commissioned papers, reflecting discussions at the conference, are in the June issue (subscription required) of the Journal of General Internal Medicine:

• "Using Evidence to Inform Policy: Developing a Policy-Relevant Research Agenda for the Patient-Centered Medical Home." Bruce Landon, James Gill, Richard Antonelli, and Eugene Rich. This paper summarizes the symposium.
  

  "U.S. Approaches to Physician Payment: The Deconstruction of Primary Care." Robert Berenson and Eugene Rich. This paper addresses why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home and the relevance of payment reforms, such as pay-for-performance and episodes/bundling.

  "How to Buy a Medical Home? Policy Options and Practical Questions." Robert Berenson and Eugene Rich. This paper describes payment options to support the patient-centered medical home and identifies conceptual strengths and weaknesses.

• "Prospects for Rebuilding Primary Care Using the Patient-Centered Medical Home." Bruce Landon, James Gill, Richard Antonelli, and Eugene Rich, Health Affairs (subscription required), May 2010. This article analyzes potential barriers in the U.S. to the patient-centered medical home model, which is considered policy shorthand for the reinvention of primary care. Barriers include developing new payment models, personnel and infrastructure funding, and methods to facilitate transforming existing practices to functioning medical homes.

• "Beyond Affordability: The Impact of Nonfinancial Barriers on Access for Uninsured Adults in Three Diverse Communities." Jeffrey Kullgren and Catherine McLaughlin, Journal of Community Health (subscription required), June 2010. To shed light on the multidimensional issue of health care access, this study identifies nonfinancial barriers to health care uninsured low-income adults in three diverse communities face. It also determines how frequently nonfinancial barriers and financial access barriers coexist in this population.
• "Racial Disparities in Hospitalizations for Ambulatory Care—Sensitive Conditions." Sasigant O’Neil, Timothy Lake, Angela Merrill, Ander Wilson, David Mann, and Linda Bartnyska, American Journal of Preventive Medicine (subscription required), April 2010. This study identified differences in hospitalization rates for elderly African Americans and whites in Maryland for eight ambulatory care-sensitive conditions and estimated excess costs associated with these disparities. The study found that African Americans had significantly higher hospitalization rates for five of eight conditions, indicating that race may be a key predictor of preventable hospitalizations. Improving care for minorities, may reduce differences in care and lower hospital costs.
• "Yes, We Can Make a Dent in Medicare Costs." Randall Brown, American Society on Aging Online (subscription required), February 2010. This article suggests that strong evidence exists on how Medicare costs can be reduced and quality of care improved for patients with chronic illnesses through enhanced attention to patients around the time they are released from the hospital. Two models of transitional care, both relying on advance practice nurses but in different ways and for differing lengths of time, have been shown to significantly reduce hospital readmission rates and costs for patients with congestive heart failure and a range of other chronic conditions. 
• "Temporal Trends in Anti-Diabetes Drug Use in TRICARE Following Safety Warnings in 2007 About Rosiglitazone." Kate Stewart, Brenda Natzke, Thomas Williams, Elder Granger, S. Ward Casscells, and Thomas Croghan, Pharmacoepidemiology and Drug Safety (subscription required), November 2009. In 2007, highly publicized warnings suggested rosiglitazone, a drug used to treat type 2 diabetes, may be associated with an increased risk of heart attack and cardiovascular-related death. This article details the response to these warnings by analyzing anti-diabetes drug use before and after the 2007 warnings in the military health system. We found that the total number of prescriptions for all anti-diabetes medications remained constant before and after the warnings, although prescriptions of rosiglitazone declined by more than 50 percent after the warnings.

Issue Briefs

• "Aging in Place: Do Older Americans Act Title III Services Reach Those Most Likely to Enter Nursing Homes?" Helping Vulnerable Seniors Thrive Issue Brief #1, Norma Altshuler and Jody Schimmel, July 2010. This issue brief, the first in a series, presents findings from the Administration on Aging’s National Survey of Older Americans Act Program Participants and assesses whether Title III services are reaching adults at higher risk of nursing home entry.

• Two issue briefs based on findings from an evaluation of the David and Lucile Packard Foundation’s Insuring America’s Children: States Leading the Way (IAC) grantmaking strategy examine state-based advocacy work and identify lessons learned for effectively supporting and promoting growth of children’s health coverage.

  "State-Based Advocacy as a Tool for Expanding Children’s Coverage: Lessons from Site Visits to Six IAC Grantee States." Insuring America's Children: States Leading the Way, Evaluation Brief #1. Ian Hill, Sara Hogan, Debra Draper, and Allison Liebhaber, July 2010. This brief summarizes key findings gleaned from site visits to states where IAC has made multiyear "Finish Line" grants. These findings describe the importance of persistence, flexibility, creativity, and commitment to conducting effective states-based advocacy as well as building strong, broad-based coalitions including grassroots and state-level stakeholders. While acknowledging that much work remains, the brief cites important gains in children’s coverage since the IAC efforts began, despite the economic downturn.

  "Strategic Engagement of Policymakers Is Key to Advancing a Children’s Health Care Coverage Policy Agenda." Insuring America's Children: States Leading the Way, Evaluation Brief #2. Debra Draper, Laurie Felland, Ian Hill, and Sara Hogan, July 2010. This brief examines how policymakers’ positive engagement can benefit children’s health care coverage advocates, as well as the strategies for making this engagement happen. Key strategies include understanding states’ unique political environments; identifying, nurturing, and supporting political champions; creating strategic links between grassroots organizations and policy advocacy groups; creating effective, appealing messages for policymakers; establishing advocacy groups as the “go-to” resource for  reliable data and information; and sharing ownership of agendas and successes with champions and key policymakers.

• "Politics and Policy of Comparative Effectiveness: Looking Back, Looking Ahead." Topics in Health Care Effectiveness #1. Eugene C. Rich and Elizabeth Docteur, June 2010. Interest in evaluating which health care interventions work best under what circumstances has surged in recent years as health care spending has risen. This brief, the first from Mathematica’s Center on Health Care Effectiveness, looks at the new comparative effectiveness research (CER) initiative passed as part of health care reform. The authors discuss the status of four ongoing policy challenges relevant to the successful implementation of CER: funding mechanism, how the research gets used, how the CER enterprise is directed, and perhaps most fundamentally, the proper scope of CER. They note important questions remain whose resolution may prove critical to the future role of this research in U.S. health care.
• "Medicare Advantage 2010 Data Spotlight: Plan Enrollment Patterns and Trends." Marsha Gold, Dawn Phelps, Gretchen Jacobson, and Tricia Neuman, June 2010. This spotlight examines enrollment trends in Medicare Advantage plans, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), and private fee-for-service (PFFS) plans. Despite the availability of many private Medicare Advantage plans, enrollment is highly concentrated among a small number of firms.
• "The Starting Point: The Balance of State Long-Term Care Systems Before the Implementation of the Money Follows the Person Demonstration." Carol Irvin and Jeffrey Ballou, Reports from the Field #4, May 2010. The fourth report of the Money Follows the Person (MFP) Demonstration provides an early assessment of the balance of home and community-based care services (HCBS) and institutional long-term care systems in states before MFP was implemented. By looking at the status of these long-term systems state-by-state, the assessment helps to develop a baseline to measure the program’s impacts on long-term care systems.
• "Medical Homes: Will They Improve Primary Care?" Reforming Health Care Issue Brief #6, Jill Bernstein, Deborah Chollet, Deborah Peikes, and G. Gregory Peterson, June 2010. The sixth brief in a new series on reforming health care looks at federal and state efforts to establish medical homes and notes considerations for policymakers seeking to improve access to services and the quality of care.
• "Financial Incentives for Health Care Providers and Consumers." Reforming Health Care Issue Brief #5, Jill Bernstein, Deborah Chollet, and Stephanie Peterson, May 2010. Show them the money. Health reform will emphasize financial incentives for providers and consumers to promote the use of effective health services and discourage use of marginally effective or inappropriate services. The fifth brief in a new series from Mathematica looks at evidence on the impacts of these financial incentives and draws lessons for policymakers.
• ”Disease Management: Does It Work?” Reforming Health Care Issue Brief #4, Jill Bernstein, Deborah Chollet, and G. Gregory Peterson, May 2010. Disease management programs seek to control health care costs by focusing on two major drivers:  high-cost chronic illness and inpatient hospitalizations for acute conditions. The fourth brief in a new series from Mathematica looks at the research evidence on the effectiveness of disease management programs and the role of disease management in health care reform.
• "Basing Health Care on Empirical Evidence." Reforming Health Care Issue Brief #3, Jill Bernstein, Deborah Chollet, and Stephanie Peterson, May 2010. What does the evidence show? Federal reform embraces the development of evidence-based practice as a way to control health care costs and improve quality. The third brief in a new series from Mathematica reviews initiatives under way to develop evidence of comparative effectiveness and put it into practice.
• "Encouraging Appropriate Use of Preventive Health Services." Reforming Health Care Issue Brief #2, Jill Bernstein, Deborah Chollet, and G. Gregory Peterson, May 2010. Is an ounce of prevention worth a pound of cure? The second brief in a new series from Mathematica summarizes evidence on the benefits and cost-effectiveness of preventive health services, noting that health reform brings significant new opportunities to improve access to preventive care.
• "How Does Insurance Coverage Improve Health Outcomes?" Reforming Health Care Issue Brief #1, Jill Bernstein, Deborah Chollet, and Stephanie Peterson, April 2010. This brief synthesizes the compelling research evidence linking health insurance coverage to good health outcomes for both adults and children.
• "System of Care Approaches in Residential Treatment Facilities Serving Children with Serious Behavioral Health Needs." Kamala Allen, Sheila Pires, and Jonathan Brown, March 2010. This issue brief describes findings from a national survey of residential treatment facilities (RTFs) serving children and adolescents with serious behavioral health challenges. The survey explored how system of care principles are reflected in RTFs’ policies and practices as well as how RTFs are providing home- and community-based services and supports in addition to traditional offerings.
• "Quality’s New Frontier: Reducing Hospitalizations and Improving Transitions in Long-Term Care." Debra J. Lipson and Samuel Simon, March 2010. Hospitals and post-acute care providers have developed quality measures to evaluate their effectiveness in preventing readmissions, but these measures are lacking in long-term care. This issue brief discusses the need for similar measures to assess the quality of long-term care for people in nursing homes and other home- and community-based service settings. It also identifies evidence-based care models and interventions for reducing potentially avoidable hospitalizations and highlights the need to develop financial incentives for providers to measure and improve performance.
• "Coordinating and Improving Care for Dual Eligibles in Nursing Facilities: Current Obstacles and Pathways to Improvement." James M. Verdier, March 2010. More than half of all nursing facility residents are dually eligible for both Medicare and Medicaid, enmeshing them in a system of care and coverage that is complex, fragmented, uncoordinated, and inefficient. This policy brief suggests that coordination of care for these dual eligibles could be improved by shifting responsibility for long-term nursing facility services from Medicaid to Medicare. Some incremental steps could also increase accountability for prescription drug use, reduce avoidable hospitalizations, cut costs, and improve overall care. It is important to ensure that Medicaid home- and community-based service programs and nursing facility care remain coordinated for those who can be cared for in the community.

Other

• Mathematica recently completed three white papers for the Agency for Healthcare Research and Quality (AHRQ) examining how the patient centered medical home (PCMH) can promote patient and family engagement in primary care, ways to improve the delivery of mental health care by the primary care practice, and the role of the Health Information Technology and Clinical Health (HITECH) Act in developing and supporting medical homes. 

  "Engaging Patients and Families in the Medical Home." Sarah Hudson Scholle, Phyllis Torda, Deborah Peikes, Esther Han, and Janice Genevro, June 2010. This paper offers policymakers and researchers insights into opportunities to engage patients and families in the medical home. It presents a framework for conceptualizing opportunities for engagement, reviews the evidence base for these activities, describes examples of existing efforts, suggests key lessons for future efforts, and discusses implications for policy and research.

  "Integrating Mental Health Treatment Into the Patient Centered Medical Home." Thomas Croghan and Jonathan D. Brown, June 2010. This paper identifies the conceptual similarities in and differences between the PCMH and current strategies used to deliver mental health treatment in primary care. The paper finds that even though adoption of the PCMH has the potential to enhance delivery of mental health treatment in primary care, several programmatic and policy actions are needed to facilitate integration of high quality mental health treatment within a PCMH.

  "Necessary But Not Sufficient: The HITECH Act and Health Information Technology’s Potential to Build Medical Homes." Lorenzo Moreno, Deborah Peikes, and Amy Krilla, June 2010. This paper examines how the HITECH Act could be harnessed to help practices implement technology and support key principles of the PCMH.

• Massachusetts has been a leader in experimenting with and implementing health care reform initiatives. The Massachusetts Special Commission on the Health Care Payment System recently endorsed recommendations for improving the quality of health care by dramatically changing the way patients pay for care. Staff from Mathematica, led by Deborah Chollet, Bob Schmitz, and Tim Lake, drafted the report and background material for the commission. Read about the recommendations and access the full report. (See page 73 for Mathematica’s role; Appendix C contains the memos we prepared.) The report was covered in the New York Times, Wall Street Journal, Boston Globe, and other media.